Essential Health Care Planning Documents

Health Care Power of Attorney

Every person over 18 years of age needs a Health Care Power of Attorney. A Health Care Power of Attorney names someone to make health care decisions for you if you are unable to make or unable to communicate the decision yourself. You should name an alternate in the event the first named individual is not available. A health care power of attorney is activated by a physician who determines that you are not able to make or communicate health care decisions. North Carolina has enacted a statutory form that may be used. The form was extensively modified in 2007. If your health care power of attorney was signed in 2007 or before, you should consider revising it.

HIPAA Waiver

The health care power of attorney includes a HIPAA waiver, which means the agent you have named can have access to your protected health information if a physician has activated the health care power of attorney. Generally, the agent named in the health care power of attorney will not have access to your protected health information unless a physician has determined that you are unable to make or communicate health care decisions yourself.

If the health care power of attorney has not been activated and you want someone to be able to talk to your doctors and have access to your health care information, you need a HIPAA waiver. This allows your agent to access your health care information while you still have capacity to make health care decisions. This is often helpful for individuals who want children or others to accompany them to their doctor’s appointments, but some individuals do not want anyone to have access to their protected health care information unless they no longer have the ability to make or communicate a health care decision.

Advance Directive for Natural Death (Living Will)

An Advance Directive for Natural Death, also called a Living Will, is a document that sets forth your desires in certain end of life circumstances. The Directive can either be binding on your health care agent or not. If you want your health care agent to have the final say in end of life situations, assuming, of course, that you are not capable of making those decisions yourself, the living will can serve as a guide for your health care agent. You can make the living will mandatory if you wish. In that case the health care agent has no power to override your decision. Some people prefer to leave the final decision in the hands of others they trust. Other individuals feel strongly about end of life care and do not want to leave the decisions to others. North Carolina has a statutory form that may be used. The form was extensively modified in 2007. If your living will is older than that, you should consider revising it. The Living Will and the Health Care Power of Attorney can be revoked orally as long as you have the capacity to understand that you are revoking it.

MOST Form

A MOST form is a physician’s order. MOST stands for Medical Orders for Scope of Treatment. A physician, physician’s assistant or nurse practitioner has to prepare and sign the form. The patient also has to sign the form. The physician discusses the conditions covered by the MOST form with the patient, with the parent of a minor or with a health care representative for the patient.

The first part of the form deals with CPR if the person has no pulse and is not breathing. The second part deals with scope of medical treatments if the person is breathing and has a pulse. A separate section deals the administration of antibiotics and the last section deals with tube feeding and IV fluids.

The biggest drawback to using a MOST is that is must be reviewed annually to remain in effect. In addition, it must be reviewed if the patient is admitted to a health care facility. This means that every year or each time the patient is admitted to a health care physician, the physician and the patient will have to sign the form.

DNR

A DNR is a Do Not Resuscitate Order. Like MOST, a DNR order is a physician’s order and it must be signed by a physician, physician’s assistant or nurse practitioner. A DNR provides that in the event your heart or breathing stops, CPR should not be initiated. A DNR can only be signed with the consent of the patient or the patient’s representative. The Order does not affect other medically indicated care or comfort care.

If you have questions about any of these documents, call our office to set up a time to discuss.